# Comparison of Core Decompression and Fibular Strut Graft in Early Avascular Necrosis of the Hip: Assessment of Postoperative Pain and Functional Outcomes

## TL;DR

This study compares two surgical treatments for early hip avascular necrosis, finding that core decompression may lead to less postoperative pain and better short-term function than fibular strut grafting.

## Contribution

The study provides locally relevant data comparing core decompression and fibular strut grafting for early hip avascular necrosis in a specific population.

## Key findings

- Core decompression was associated with fewer patients experiencing significant postoperative pain compared to fibular strut grafting.
- HOOS functional scores showed a trend favoring core decompression but did not reach statistical significance.
- The study highlights the need for larger, longer-term studies to confirm these findings and guide clinical recommendations.

## Abstract

Introduction: There is limited local data comparing the outcomes of core decompression and fibular strut grafting in early-stage avascular necrosis (AVN) of the hip. International findings may not be directly applicable due to population-specific factors such as genetics, lifestyle, and healthcare access. Early identification of the optimal surgical option is essential for improving patient counseling, postoperative recovery, and overall clinical outcomes.

Objective: To compare postoperative pain and functional outcomes of core decompression versus fibular strut grafting in patients with early-stage AVN of the hip.

Methodology: This prospective, randomized comparative cohort study was conducted at the Department of Orthopedic Surgery, Khyber Teaching Hospital, Peshawar, from 14th March 2023 to 13th September 2023. A total of 112 patients aged 18-50 years with Ficat and Arlet stage I-II AVN were enrolled and equally allocated into the core decompression or fibular strut graft groups using blocked randomization. Postoperative pain was assessed at 12 weeks using the visual analog scale (VAS), with a score >3 considered significant. Functional status was evaluated using the Hip Disability and Osteoarthritis Outcome Score (HOOS). Data were analyzed using chi-square tests for categorical variables and appropriate tests for functional scores, with p ≤ 0.05 considered statistically significant.

Results: Significant postoperative pain (VAS > 3) was observed in 11 (19.6%) patients in the core decompression group and 17 (30.4%) in the fibular strut graft group (χ² = 1.708, p = 0.190). Stratification by age, gender, and BMI consistently showed lower pain rates in the core decompression group, though differences were not statistically significant. HOOS functional scores demonstrated a similar trend favoring core decompression, but these differences also did not reach statistical significance.

Conclusion: Core decompression was associated with fewer patients experiencing significant postoperative pain and showed a trend toward better short-term functional outcomes compared to fibular strut grafting. Its minimally invasive nature may make it a preferable option for early pain management in patients with early-stage AVN of the hip. However, the lack of statistical significance and the short follow-up period warrant further studies with larger sample sizes and inclusion of long-term functional and radiological outcomes before definitive clinical recommendations can be made.